I submitted the “op-ed” below to the Los Angeles Times for consideration, the response I got back was “I don’t think we can run this as an op-ed…” I called to find out why and Robin (Editor, Op-ed) went on to explain that my op-ed was too personal.  Well, I’m sorry to say that to this LA County resident, health activist, and RN the health of our county’s health department is well – personal.  Just ask the residents of South Los Angeles if the loss of King/Drew wasn’t personal and the eight (8) years they waited for it to be rebuilt, personal.  Ask the allied healthcare workers, nurses, and physicians of our four (4) County hospitals if the health and wellbeing of these hospitals and assorted urgent cares and clinics aren’t personal.

Robin asked my permission to share my email with one of the LA Times reporter, but I’ve crossed paths with this reporter in the past so I won’t hold my breath waiting for her to call me back.  In the meantime below is my letter to the Los Angeles Times, more to come…

Los Angeles County Supervisors “fiddle” while the Department of Health Services “burns”.

The LA County Department of Health Services has seen a turnover of directors over the years, and filling that vacant position has often required a tedious and time-consuming search process.  So, its understandable that the LA County Board of Supervisors would choose to appoint an internal candidate, Dr. Christina Ghaly, as the new DHS director rather than undergo yet another long search.  However, choosing expediency over an actual job search process means our County is now paying the price.

Prior to Ghaly’s appointment as our new director of DHS she was appointed to head County LAC+USC.  During her tenure, she managed to lower LAC+USC’s Leapfrog score from a B to a D.  As if it wasn’t enough that Ghaly’s management style lead to a two grade drop in one County-run hospital we had to see if she could do it again, so she was later appointed to run Olive View.  True to Ghaly’s management style it wasn’t long before she drove Olive View from a B to a D grade.

After leaving Olive View, Ghaly was made the Chief Operating Officer for DHS before she was made Interim and then permanent Director.  She’s therefore really been “in charge” of DHS for 2.5 years now.  Only in LA County would this track record be rewarded with being offered the position of Director of the Department of Health Services.  If Ghaly’s past management failures weren’t enough to give the Supervisors reason to rethink their hiring decision, you’d think the recently revealed “2018 Patient Safety Culture Survey” by Press Ganey would.  That survey, completed by more than 12,000 DHS employees, showed DHS hospitals scored lower than the National Average and National Safety Net Hospital Average on all 24 of 24 questions asked.  These results are a damning summary of Ghaly’s leadership, as they reflect the perceptions of DHS employees regarding how DHS treats both its patients and staff.  The results of this survey were only revealed to the Supervisors after I handed copies of the one page aggregate to each of them, something Ghaly, herself should’ve done – but considering the dismal scores it’s not surprising that she was too ashamed to provide the information herself”.

Later, Ghaly would produce a 10-page report where she tried to explain away why our County hospitals ranked so poorly.  Ghaly even went so far as to try to rationalize that our County RNs and other advanced practice providers were using the survey as a negotiating tactic (a nursing strike loomed on the horizon), by writing the following: “In sub-group analysis, the negative trend was in large part driven by the responses of RN and Advanced Practice Providers within DHS. DHS will conduct a series of focus groups and perform other focused data analyses to determine why this change may have occurred, the extent to which it may have been related to ongoing labor negotiations that were occurring at the time of the survey, and how to address and improve perceptions among our nursing staff about the climate of safety across DHS.” 

The DHS system is in trouble.  The academic environment at Harbor-UCLA has been collapsing for some time.  Harbor-UCLA hasn’t been able to recruit a new Chair of the Department of Medicine after 5 years and 3 failed national searches.  Indeed they seem unable to recruit leaders generally; their Chairs of Surgery, Pediatrics, OB-Gyn, and Anesthesia are all internal promotions.  After Ghaly left LAC+USC as Interim CEO, their Leapfrog scores began to recover from the D back up to a B.  But since she took over as DHS COO and then Director, their scores have tanked back to a D.  This may have something to do with the fact that in a period of little more than a year, Ghaly has turned over leadership at the hospital an absurd amount of times—4 CEOs, 3 COOs, 3 CFOs, and 3 CQOs in such a short period of time.  Meanwhile, the medical staff at Olive View has been in revolt, forcing out their CMO, and complaining about DHS leadership.  There are fires burning all across DHS, and people are being hurt as a result.

Not to mention the enormous amount of money DHS has wasted under Ghaly in what can only be described as incompetence in modern data analytics.  The availability of data is the lifeblood of a quality improvement program—as I know well, having run QA at Cedars Sinai Medical Center in my past.  After spending years and tens of millions of dollars attempting to build an internal data repository known as CEDAR, DHS recently hired an expensive consulting firm, Gartner, to assess their data readiness.  I’m told that at a recent report-out downtown, Gartner assessed DHS as having the lowest possible data readiness, despite years and millions of dollars spent.

Meanwhile, I started receiving calls and e-mails from many County employees, including physicians, complaining about Ghaly.  Many explained that she rules through fear and intimidation, and that she doesn’t listen to anyone, including many people who have far more experience than she does.  Many also said that she brags that she only answers to the Board of Supervisors.

I’ve also heard that she seems to prefer to hire “yes people” who ask no questions and never challenge her, rather than hiring the quality of people to ensure the highest quality of service to staff and patients in the Health System.  I’m not sure how true this is, but I can tell you that after Mr. James Brady was hired over Ms. Pam Griffith the DHS Dashboard has been riddled with a computer glitch that yields “N/A” which provides no information on some key and critical data points.  A glitch that Mr. Brady hasn’t been able to resolve which might’ve something to do with that fact that his experience is with two small hospitals in the self-developed Kaiser system rather than Cerner/Orchid  (which the County uses) which Ms. Griffith fully understood and was proficient in.

Not all that long ago our Board of Supervisors failed to recognize that King/Drew Medical Center was in critical condition and by the time they did; all the corrective action taken wasn’t enough to stop King/Drew Medical Center from losing its accreditation and closing.  It’d take nearly 8 years to re-open the Martin Luther King, Jr. Community Hospital, a much smaller hospital with a smaller footprint and mission.  I hope that the current red flags being revealed in various safety surveys and key indicators aren’t a warning that the Supervisors will choose to ignore.  It’s often hard to acknowledge that as a group you made a bad choice, but as the evidence continues to mount the Supervisor’s need to rethink their original decision. Raising all the money in the world shouldn’t offset the fact that Ghaly appears to be hiding critical performance and safety issues from the Supervisors and that’s called dereliction of duty.

The Supervisors should remember that Ghaly is an “at-will-employee” and can on any given Tuesday by a vote of three be sent packing.  This LA County health activist and RN wonders how many more of our at-risk children need to die or how much lower in quality of care must the hospitals that so many of our most vulnerable residents rely on for their care must fall before the Supervisors take that vote of three?

Geneviève M. Clavreul, RN, PhD